DM1.ppt

National Rural Health Mission
for Primary Health Care?
Dr. Dhruv Mankad
Sr. Consultant, School of Health
Science, YCMOU, Nashik

Thursday, June 18, 2009 YSP5-IGIDR
Primary Health Care – Indian
vision, 1946
‘If it were possible to evaluate the loss, which this
country annually suffers through the avoidable
waste of valuable human material and the
lowering of human efficiency through
malnutrition and preventable morbidity, we feel
that the result would be so startling that the
whole country would be aroused and would not
rest until a radical change had been brought
about' (Bhore Committee Report 1946).

What is primary health care?
VI
• Primary health care is essential health care
based on practical, scientifically sound
• socially acceptable methods and technology
made universally accessible to individuals and
families in the community through their full
participation and
• at a cost that the community and country can
afford
Alma Ata Declaration, International Conference on Primary Health
Care, Alma-Ata, USSR* , 6-12 September 1978
* Now Almaty, Kazhakstan

Primary Health Care – an Alma Ata
product
VI
• It forms an integral part both of the country's
health system, of which it is the central function
and main focus, and of the overall social and
economic development of the community.
• It is the first level of contact of individuals, the
family and community with the national health
system bringing health care as close as possible
to where people live and work, and constitutes
the first element of a continuing health care
process.

Primary Health Care – an Alma Ata
product
• VII Primary health care:
1.reflects and evolves from the economic
conditions and sociocultural and political
characteristics of the country and its
communities and
2.is based on the application of the relevant
results of social, biomedical and health
services research and public health
experience;

Alma Ata Declaration 1978
3. addresses the main health problems in the community,
providing promotive, preventive, curative and
rehabilitative services accordingly;
4. includes at least: education concerning prevailing
health problems and the methods of preventing and
controlling them; promotion of food supply and proper
nutrition; an adequate supply of safe water and basic
sanitation; maternal and child health care, including
family planning; immunization against the major
infectious diseases; prevention and control of locally
endemic diseases; appropriate treatment of common
diseases and injuries; and provision of essential drugs;

Alma Ata Declaration, 1978
5. involves, in addition to the health sector, all related
sectors and aspects of national and community
development, in particular agriculture, animal
husbandry, food, industry, education, housing, public
works, communications and other sectors; and
demands the coordinated efforts of all those sectors;
6. requires and promotes maximum community and
individual self-reliance and participation in the
planning, organization, operation and control of
primary health care, making fullest use of local,
national and other available resources; and to this end
develops through appropriate education the ability of
communities to participate;

Alma Ata Declaration, 1978
6. should be sustained by integrated, functional and
mutually supportive referral systems, leading to the
progressive improvement of comprehensive health
care for all, and giving priority to those most in need;
7. relies, at local and referral levels, on health workers,
including physicians, nurses, midwives, auxiliaries and
community workers as applicable, as well as traditional
practitioners as needed, suitably trained socially and
technically to work as a health team and to respond to
the expressed health needs of the community.

Features of PHC -1
•Primary Health Care = a
paradox, it is complex

Factorspectrum of Health

Primary Health Care Spectrum

Features of PHC - 2
•Primary Health Care involves
community, evolves from its
social, cultural, political context

Features of PHC - 3
• Primary Health Care has
multidimensional, multidisciplinary,
multiagency approach

Content Activities Ministries/Agencies involved
Food Supply
Grains, Cereal, Tuber, Vegetables and
Fruit production Agriculture, Animal Husbandry, Fisheries
Proper Nutrition Milk and dairy products, meat and fish
Animal Husbandry, Dairies -
pvt/cooperatives, FDA
Food supply Agricultural Produce Markets Ration Shops
Food quality, safety FDA
ICDS, Women and Child Development
Safe Water
Drinking Water Resources, Sewage
drainage and disposal, Water
purification, Forest and Water
Conservation, Irrigation
PWD, Sewage drainage and disposal, Water
purification agencies, water purifier
producers
Sanitation Solid waste disposal PWDs, Urban Planning, Environmental
Mother (Women)
Care
Marriage registration, ANC, PNC, CaCx
detection, family planning
Public Health and Family welfare, FDA,
Pharmaceutical and Health device industry,
Gynaecological and Obstetric public and
private hospitals, fertility clinics
Child care
Trained Birth Attendant, Institutional
delivery, Birth registration, early Breast
feeding, Immunization, treatment of
illnesses, early child care
Public Health and Family welfare, FDA,
Pharmaceutical and Health device industry,
Paediatric clinics/hospitals, vaccine
industry

Content Activities Ministries/Agencies involved
Endemic Disease NHPs
Public Health departments, Integrated
surveillance system, Public and Private
health care providers, Pharmaceutical and
Health device industry,
Preventing methods
Pollution Control, Occupational
Hazards
All of above, Environmental Board, Traffic
Control, Disaster Management
Treatment of common
illnesses and
injuries Diagnose and treat illnesses
Essential drugs Treat common illnesses
Health Education For about all of the above
IEC bureau, Education ministry and
institution, ICT, ISRO, telecommunication,
communication media incl internet, radio,
television and film industry, advertisement

TRENDS IN RURAL PRIMARY
HEALTH CARE SERVICES

PHC Status in India
• ''In rural areas, there are no doctors. They
(PHCs) are functioning only on paper.
There is no facility at PHCs. Hospitals
function without any doctor,''
− a SC bench comprising Chief Justice K G
Balakrishnan and Justices Ashok Bhan and
P Sathasivam *
* ToI 2nd October 2008

STATUS OF RURAL HEALTH
SERVICES
• Greater Burden of Diseases
• Lower coverage of public health services
• Inequality in workforce distribution/
accessibility – globally, nationally

What about our villages,
city wards?
• Is there an equal distribution of HWs in
villages? Trend is – NO!
• One HW per 16 villages – Nasik survey
• Situated at market towns, In towns, at
marketplaces
• Shift from residential to market, from
family health care to consultancy!

Health Workforce in villages
Districts
1 doctor per
no. of villages
1 doctor per
rural
Population
Jalna 8 11346
Khammam 6 10340
Kozhikode 0.2 3180
Nadia 4 10820
Udaipur 4 4006
Ujjain 4 3612
Vaishali 6 10549
Varanasi 3 3979
Total 4 5963

PHC – Demand v/s Supply

PHC Economics – Current Scenario*
• RURAL (Primary/
Secondary) per 1000
Beds 0.2
Doctors 0.6
PE 80,000
OoPs! 750,000
IMR 74/1000 LBs
U5MR 133/1000 LBs
Births Attended 33.5%
Imm. 37%
ANC median 2.5
• URBAN (Secondary/
Tertiary) per 1000
Beds 3.0
Doctors 3.4
PE 560,000
OoPs!! 1,150,000
IMR 44/1000 LBs
U5MR 87/1000 LBs
Births Attended 73.3%
Imm. 61%
ANC median 4.2
* www.vatsalya.com based on CII McKinsey Study, 2001

PHC Current Scenario
Public Private
Rural Existing, Low
public exp,
Inaccessible, Weak
performance
Sporadic,
Inaccessible,
un/affordable,
Weak performance
Urban Low existence,
High public exp,
accessible, Mod.
performance
Strong existence,
Un/affordable,
Accessible, Good
and Limited
performance

WHY NRHM? PROBLEM 1
• High and Static IMR
• High Out of pocket expenses
• Population Stabilization unstable
• Public Health System thinning down

WHY NRHM – PROBLEM 2
• Community involvement low
• Health structure run with saline-
syringes
• NGO involvement also low
• Pvt sector though large not linked
with public health programmes

WHY NRHM – PROBLEM 3
• Budgetary Allocation to Health had
declined 1999 – 2002
• GoI contributing less than State
• Health care services not for poor
• 10% covered under insurance
• Hospitalized patients pay about 58% of
their annual income, 40% borrow
ALL THESE WHEN WE HAD COMMITTED IN
1946!

A Rural Primary Health Care package
 Universal Health Care
 Accessibility and Affordability
 Quality and Equity
Reduce IMR, MMR, TFR
NRHM - GOALS

NRHM - THE VISION
• Architectural correction in health care delivery
• Special focus on 18 states with weak indicators.
• Improve availability of quality health care in rural
areas
• Synergy between health and determinants of good
health
• Mainstream the Indian Systems of Medicine.
• Capacity Building.
• Involve the community in the planning process.

EXPECTED OUTCOMES
2005 - 12
• Universal Quality Health care.
• IMR reduced to 30/1000 live births
• MMR reduced to 100/100,000 live births
• TFR reduced to 2.1
• Malaria Mortality Reduction Rate – 60%
• Kala Azar eliminated by 2010, Filaria
reduced by 80 % by 2010
• Dengue Mortality reduced by 50% by
2012
• TB DOTS series – maintain 85% cure rate
• Responsive Health System

Indicator 2005-06 2006-
07
2007-
08
2008-
09
2009-
10
Institutional
Deliveries
54.1 56.6 59.1 61.6 64.1
Skilled birth
Attendants
58.8 61.8 65.8 69.8 74.3
Fully Immunized
Children
80.6 83.6 88.6 90.6 93.6
Couple
Protection Rates
59.7 61.7 64.7 66.7 69.7
Full ANC care
Received
50.8 55.8 62.8 69.8 78.8
Unmet Need for
Family Planning
4.2 3.2 2.7 1.7 1.0
Goal Indicators

NRHM components
A RCH II
B Innovation under NRHM
C National Health Programs
D Disease Surveillance
Programs
E Inter-sectoral convergence

• Public Health expenditure - 2 – 3 % of GDP
• Merger of societies at District level
• Integration of existing schemes
• Decentralized planning
• Intersectoral convergence with other Health
determinants
• Community ownership of Health facilities
• Upgradation of CHCs / PHCs to IPHS
• Mainstreaming of AYUSH
• Partnership with non Government providers.
• Risk Pooling
• Fully trained ASHA in each village.
What’s New

NRHM-5 MAIN APPROACHES
COMMUNITIZE
IMPROVED
MANAGEMENT
THROUGH CAPACITY
BUILDING
MONITOR
PROGRESS AGAINST
STANDARDS
INNOVATION IN
HUMAN
RESOURCE
MANAGEMENT
FLEXIBLE
FINANCING

State and District Health
Mission
• State Health Mission led by
CM –
• SPMU - Mission Directorate,
SHRC
• Prepare and approve State
Health Action Plan

State and District Health
Mission
• District health mission led by
chair ZP, DHO, dept reps,
• DPMUs
• Prepares and implements
DHAP

Village Empowerment
• Village Health, Nutrition, Water
& Sanitation Committee
(VHNWSC)
• Village level revolving funds
• Preparation of village specific
plans
• Convergence of all
developmental activities

Reproductive and Child Health
(RCH) programme
Major component of NRHM
• Maternal Health
– 24x7 hrs services
– JSY
– Additional ANMs
– On contract Experts
– Infrastructure upto IPHS std
• Child Health
• Reproductive Health of Men and Women

Reproductive and Child Health
(RCH) programme
Major component of NRHM
• Child Health
– Immunization: BCG,OPV, DPT, TT, HepB
• Reproductive Health of Men and Women
– Family Planning
• OP, Tubectomy, CuT for women
• Condom, Non scalpel vasectomy for men
– Safe Abortion
– STD
– Adolescent RCH

Reduce maternal and infant death
thru’ institutional deliveries
JSY – AN INTEGRATED PACKAGE:
 Tracking entire pregnancy period Adopt Micro-
birth plan
 Providing appropriate referral and transport
assistance,
 Building an effective link between service provider
and pregnant woman, through ASHA
PLUS CASH ASSISTANCE
RCH II Janani Suraksha
Yojana

• PROVISION FOR CAESAREAN SECTION :
– Empanel private/Govt. doctors,
– up to Rs. 1500/- per case for hiring services
of experts from private sector,
– If private doctors are not available, utilize
this amount for providing honorarium to
Govt. specialist.
RCH II Janani Suraksha
Yojana

N H Ps
• Revised National TB Control program
• National Vector Borne Diseases Programs,
eg Malaria, Urban Malaria, Dengue,
Chikunguniya, Filaria, Japanese
Encephalitis, Swine Flu
• National Leprosy Eradication Program
• National AIDS control Programme
• National STD Control Programme

N H Ps
• National Blindness Control Program eg Cataract
Operations, Refractory Errors in school children
• National Leprosy Eradication Program
• National Iodine Deficiency Control Program by
promoting iodated salt
• National Mental Health Programme
• National Cardio-vascular Diseases Control
Programme
• National Cancer Control Program
• National Occupation Disease Control Program
• National Diabetes Control Program

Revised National TB Control
Programme (RNTCP)
• Operational Structure
– Central Govt : Dy DGHS (TB)
– State Govt : State TB Cell with STO
– District: DTU with DTO
– Sub District – MO – TC ( 1 per 5/2.5 lakhs)
– Designated Microscopy Centre (DMC): for Med
College, NGO, Pvt Hospital nodal point for record
report at Sub District Level
– Peripheral Health Inst
• Diagnostic Laboratory Services
• Drug Stores

Revised National TB Control
Programme (RNTCP) – Lab/DOTS
• Central Laboratories with international
recognition at Chennai, Bangalore and
Delhi
• DMC and Sputum Collection Centres
networks
– Case Detection, finding and Diagnosis of Lung
TB
• DOTS

53
 OPERATIONALIZE 24/7 SERVICES – PHC & FRU
ACCREDIT PRIVATE INSTITUTIONS:
 Empanel atleast two accessible private health
institutions in each Block,
 Draw up a protocol of services to be delivered at these
recognized health centers,
 Give wider publicity to such institutions by displaying
names of such institutions in every PHC/CHC/District Hospital
and the sub-center,
Constant monitoring of the Quality of services
Infrastructure Improvement

24 X 7 PHCs
Pre requisites for 24 x 7 PHC
delivery services
Sterilization services
STI / RTI management
Safe Abortion services (MVA)
24 x 7 services
 Identify gaps & address appropriately
Repair of physical structure – labour room & OT
Skill enhancing training of MO, SBA
Transport & referral
Logistic support
Provision of 24X7 delivery services at least in
50% PHCs

PHCs
Strengthening PHCs
• Supply of essential drugs to PHCs
• Upgrading single-doctor PHC to two-doctor
PHC by posting AYUSH practitioner
• Providing standard treatment protocols
and training medical officers / paramedics
in their use
Repairs for SC / PHC:
• Sub-center upto Rs. 50,000/-
• PHC upto Rs.1.00 lakh

New and Old Construction
• Additional 2627 SCs, 394
PHCs, 95 FRUs
• Improvement Training
Centers
• Maintenance of existing and
new construction (35 DHs,
500 FRUs, 2200 PHCs)

Strengthening Sub-centres
•Untied fund @Rs.10,000/-
•Supply of essential drugs
•Additional outlays: local
ANMs on contract etc.

Workforce
Planning
Political
Commitment
Motivational
Environment
CRITICAL FACTORS
Long term
•recruitment
•training
•Pre service
training
•Sustained
Long term efforts
•High Investment
•Information
• Incentive and
Motivating work
environment
TRAINING POLICY
Quick Fix Medium term Long term
ODL, On Job,
Flexi
Curriculum reform
Outsource trg,
Build Instt
KMC
More Primary
Care Providers
More Nurse, MPH
More Spl Dr,
MDG 6 MDG 5 MDG 4
CHR ILLNESSES

ASHA (NRHM)
•Accredited (Trained through recognized
institution)
•Social (NGO-SHG-PRI network)
•Health (managing biomedical and social
determinants of health)
•Activist (non-profit based services, and
community active model)

ASHA: TASKLIST
• Village microplanning with others
• Improvement of hygiene and sanitation
through IEC-BCC
• Maternal and child health, helping AWW
and ANM, for preventing malnutrition
• Basic medical care
• Referral and JSY
• Depot holder for DOT and malaria
• Helping in all National Health
Programmes (NHP).
• Reporting outbreaks and keeping basic
health records

ASHA: TRAINING
• Home based neonatal care
• Treatment of common childhood
illnesses like diarrhea, ARI
• Identification of high risk mother
& child & appropriate referral
• Health & nutrition education

ASHA – YCMOU’s Arogyamitra
• Woman selected by GP/ SHG/ Youth
• VII std
• 21 years age
• Training 28 days (32 CPs)
• Fee = 800 YCMOU, 2500 SC
• 5 books+Wkbk+exam

Arogyamitra Program
2007-08 Results
Women
Learners
Men
Learner Total
No. % No. % No. %
Passed 305 77 224 78 529 78
0-49.99
(Failed) 90 23 63 22 153 22
Total 395 100 287 100 682 100

CHW measuring respiratory rate

CHWs trained for treatment for
minor ailments

Strengthening Nursing
• Strenghtening SCs with
12000 ANMs
• Strengthening 21 Training
Schools
• Strengthening PHCs with
about 1500 staff nurses,
Blocks with a PHN
• Nursing Cell at the state

Rogi Kalyan Samiti
• People’s reps, Health Officials, Local
District Officials, community Leaders
medical Supdt, IMA Rep, donors
• Flexi fund available DH, RH and PHC
level. Can raise addl. Funds to
– Improve existing services, facilities
– Introduce new services
– Can procure medicines, equipments,
recruit addl staff, have PPP MoU etc.

Services guaranteed in CHC with
IPHS
• New born care
• Routine and emergency care of
sick children
• National Health Programmes
• Blood storage facility
• Essential laboratory services
• Referral services

Quality Assurance
• Regulation
• Accreditation
• IPHS
• Revised PHC Manual and
Treatment Protocol
• RKS as Quality Assurance
Mechanism
• Citizen’s Charter and Guarantee
Scheme

Quality Assurance
Area Specific Activities
Technical
Quality
Improvement
• Standard Treatment Protocols.
• Grading of PHC done by state
government Technical parameters
• Grading of public health institutions
(CHC/FRU/DH)
• Accreditation scheme for private sector
hospitals
• CME for Private Medical Practitioners.
• Refresher's skill training to ANM, MO for
building confidence , training in IMNCI
etc.
• Management Development trainings for
program managers at all levels

Area Specific Activities
Managerial
Quality
Improvement
• Random visits to check humane approach and 3rd
delay in treatment
• Developing a procurement and distribution system
• Improved monitoring of infrastructure, staff
availability, functionality of equipment, institutions
• Equipment maintenance contract (AMC)
• Inter-departmental convergence
• Client satisfaction surveys
• Special training package
• Financial management and audit
• Use of MIS analysis and feedback
• Sensitization on gender and equity issues,
• Feedback and follow-up of trainings
Quality Assurance

District Health Action Plan
• Microplanning
• DHAP built up on Monthly
Plan
• HH facility periodic survey as
basis
• PPP with NGO, professionals

Next funds will be released on receipt
of SOEs for atleast 50% of previous
releases
Expenditure & physical performance
(no. of beneficiaries) should match
Ensure grants are used for the
purpose for which grants given
All activities in the PIP should be
initiated
Diversion of grants not permitted
PERFORMANCE BASED
FUNDING FOR RCH

State Resource Center
• An agency to pool the technical
assistance from all the
Development Partners
• A single window for consultancy
support
• for capacity building not only for
SRHM but for improving health
sector service delivery

I D S Program
• Integrated Disease Surveillance
Program
– decentralized, state based
– improve information about communicable
and non communicable diseases
– identify major risk factors incl.
environmental, social and political

I D S Program
It would also
– Improve laboratory support;
– Train stakeholders in disease surveillance and
action;
– Coordinate and decentralize surveillance
activities
– Involve private sector

Monitoring & Evaluation
• Habitation/ Village Health Register
• Periodic Health Facility Survey at
SHC, PHC, CHC, District level
• Formation of Health Monitoring and
Planning Committees at PHC, Block,
District and State levels
• Sample household and facility
surveys
• Community based monitoring

Outputs/ Outcomes Objectively verifiable
indicator (OVI)
I) General goals and objectives of NRHM
Reduction in IMR, TFR
and MMR
MMR reduced to 200 by
2010
IMR reduced by 20 by
2010
Neonatal mortality rate
reduced to 10 by 2010
TFR brought down to 2.0
by 2010

Sr.No. Overall Results Indicators Expected level of achievements
Indicators Baseline 2006-7 2007-08 2010-11
1 Contraceptive prevalence rate (Current use of any contraceptive method among
currently married women)
61.6 70 75
2.75 % Eligible couples using IUD for more than 12 months 57 60
3.6 % of mothers who delivered during past 3 years & who received IFA for 3+ months 36% 90 95
4.95 % Deliveries assisted by skilled attendants at birth One-fourth home
births (36%)
83 95
5.95 % of 24hr PHCs conducting minimum 10 deliveries/ months All 7 currently
conducting >10
del
35 50
6.5 No. of Upgraded FRUs offering 24hr. emergency obstetric care services 28? 150
7.15 % of 12-23 months of age fully immunized children 84% 90 95
8.95 % of mothers and newborn children visited within 1 week of birth among non
institutional deliveries
NA 50 60
9.6 % of children under 3 years of age with diarrhea in the previous 2 weeks who
received oral dehydration salt
NA 45 60
10.6 % of children under 3 years of age with diarrhea in the previous 2 weeks who
received oral dehydration salt
NA 45 60
11.6 Polio free status achieved since when Not yet Polio-free Polio-free
12 No. of institutions upgraded to IPHS Process begun 198 360
Selection and training of ASHA Starting year 1300

Interdepartment Convergence
• WCD for Nutrition, Women Empowerment
• TDD for Tribal Health Monitoring, Pada
Swayamsevak, Shabari taxi Yojana
• Water and Sanitation
• Rural Development for EGS, Income Gen Schemes
• Urban Development for RCH
• PWD for construction
• Med Education Dept for IDSP, Medical Audits
• MUHS for CME
• DoEdu for Annual health check up
• Missions – RJCHNMission, HDMission for Nutrition

Public Private Partnership
PPP in health is an
approach to solving
public health
problems by
complimentary
efforts of public,
private and NGOs by
contributing or
sharing their core
competency
Synergy is the spirit of better health outcomes

Current Focus of PPP in Health
• Develop strategies to utilize untapped
strengths of the NGO sector
• Enhance the capacity to meet
growing health needs
• Sharing responsibilities of public
health activities by the government
with NGO
• Reaching remote areas; target
specific group of populations
• Improving efficiency through
evolving new management structures

State Specific Innovative
Schemes
Eg in Maharashtra
1. Sickle Cell Anemia
2. State Nutrition Bureau
3. State Public Health Institute
4. Action research project eg HBNC
in 4 districts
5. Computerization of HMIS
6. Arogya Jaal - DIGITAL CHC WITH
TELE DIAGNOSTICS
7. Untied funds for awards,
scholarship, study tour etc.

Proposed District Specific
Innovations
Eg Nashik DHAP
• Management by alliance
• Transportation with Taxi

Innovations To be Tapped
• Convergence of TDD’s Taxi
scheme and referral transport for
BPL /ST patients
• Collaboration with dai for
antibleeding medicines

Lateral Thinking Options in NRHM
• Technology Options
– Water Sources, GPRS-Internet, simplify technology –
auto-destructive syringe for gentamycin (test level),
solar disinfections, ppt as trg mode, cell phone or FM
• Structural-managerial Options
– RKS in designing, financing and constructing,
managing health units, flexi funds, local procurement/
purchase
• Collaborative Options
– with NGOs, CBOs, religious, political, social,
professional organizations, military, corporate sector,
experts and volunteers

NRHM
Is it a ‘Mission Impossible IV’ ??
Workable but highly ambitious mission, bcoz…
• Mindsets ready for some U turns?
• Staff availability?
• Decentralization nebulous
• ASHA – training, supervising plan? no economic
incentive?
• Workforce training plan?
• HR environment – motivation, recruitment,
transfer, punishment posting
• Incentives to staff for retention, motivation?
• Intra department Convergence - Does the left
hand knows what the right hand is doing?

NRHM
Make it a ‘Mission Impossible IV’ !!
• Insuring Health, Ensuring Equity - Which
Health Insurance model to work?
• Is community/govt prepared for
innovations?
• Political Will – for?
– Will for a Visionary plan
– Will for High human/financial investment
– Will for real PPP : within govt., with civil
society, corporate
– Will for effective regulation

PHC ‘Economics’
“The important thing for government is
not to do things which individuals are
doing already, and to do them a little
better or a little worse; but to do
those things which at present are not
done at all”
- J. M. Keynes 1926

People’s Health Watch Report –
General Findings
• No evidence of infrastructure
improvement
• Shortage of Medicines, staff and so IPHS
facilities a far cry
• ASHA selection, training, performances
and payment distorted
• RKS defunct/ disfunctional

People’s Health Watch Report –
General Findings
• Institutional delivery incentives – a problem
– competition between ASHA, ANM, AWW etc.
– ID does not = delivery by trained or EmOC
• No decentralization/communitization
• DHAP is really TD DHAP
• Insufficient, inadequate Monitoring and analysis
documentation
• Corruption !? Reports from orissa, MP,
Maharashtra
• Political will NOT for reforms but for repackaging
SO WHAT IS THE OPTION ?

Our
Arogyabank
A proposed model of
Health Information and Care Kiosk
For A healthy life, bank upon us…

Why AB?
• Developing a first contact cae model where
there is no primary health care provider
• Addressing common health problems of
community
• Promoting activities for healthy lifestyle
• Providing referral services, pre and post
referral counseling to patients
• Managing emergency and disaster
management services
• Facilitating home based health care services

What do people need?
– Simple treatment for simple illnesses
– Monitoring health problems eg Heart
attack, Brain hemorrhage, Diabetes,
T.B., AIDS, Cancer, Malaria,
Chikunguniya etc
– Actions/steps during any outbreak
– Home based caring services for elderly,
post illness recuperating, temporarily
disabled, long term health monitoring
services
– Effective health commnication
– Screening illnesses
– Health counseling

The AB Model
• A Shelter – existing building, a shop or a
kiosk with adequate space, scrap vehicle, a
locally made shelter
like these…

The AB Model – a multiowned
model
• With logos – of implementing agency,
concept developer agency, supporting
agency: a multi logo with a logo of
Arogyamitra
• like these…

The AB Model – what all it can
have
• Furniture/Equipmen
ts
• Chair, table,
cupboard
• Stetho, BP, trays,
dressing material
• Boxes for storing
medicines
• Bandages, slings,
splints

have
• OTC medicines,
medicines for MPWs
• First Aid material
• Ayurvedic Medicines
• Homeopathic medicines
• Home remedies
• Reagents/strips for
Sugar,protein and Hb
tests
• Massage oil

have
• PC with printer, CD
drive
• Internet connectivity
• Learning Material CD
• Health Education CD
• Print materials, books
etc.
• Cellphone

The AB Model – what all it
can do
• Provide First Contatct
care through ASHA/
USHA/MPW
• Participate in Public
Health Programmes
• 0-5 child care
• Provide emergency first
aid
• Provide support care
• Screen illnesses like BP,
Diabetes, disabilities etc

The AB Model – what all it
can do
• Provide HE, School Health
• Provide information
through internet, print
material
• Contact referral units
through email, cellphone,
• Can escort patient to
secondary/ tertiary care
level
• Self learning centers

The AB Model – other possible
uses
• Health Insurance
Agency
• Healthy food,
Health and beauty
product outlet
• Non medical
equipment outlet
• Computer Literacy
Centre

Expected Impact
• Improved quality of
life of vulnerable
population
• Improved responses
from community in
personal and
collective emergencies
• An innovative primary
health care model

DM1.ppt

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